quiz 38 Flashcards
The mother of an 8-year-old female is concerned about purple “warts” on her daughter’s hands. The mother explains that the lesions started a few months ago on the right hand along the top of most of the knuckles and interphalangeal joints, and she has recently noticed them on the left hand. The child has no other complaints and the mother denies any unusual behaviors. A physical examination is unremarkable except for the slightly violaceous, flat-topped lesions the mother described.
What is the most likely cause for this patient’s finger lesions?
One of the most characteristic findings in dermatomyositis is Gottron’s papules, which are flat-topped, sometimes violaceous papules that often occur on most, if not all, of the knuckles and interphalangeal joints.
Which one of the following is true regarding the risk of inducing cancer with CT scanning? (check one)
A. CT of the chest is associated with a greater risk than CT of the head
B. The risk increases with age at the time of the scan
C. Males have a greater risk of ultimately developing CT-induced lung cancer than females
D. Current techniques with rapid scanners make the risk comparable to that associated with standard radiographs of the same area
E. The risk in neonates is markedly reduced because of the efficiency of DNA repair processes at this age
CT of the chest or abdomen leads to significantly more radiation exposure and cancer risk than CT of the brain. Younger patients, including neonates, have a greater lifetime risk of developing cancer after radiation exposure, and CT imaging carries substantially more risk than plain radiographs of the same area. Women are at greater risk for developing lung cancer after a chest CT than men, and CT also increases their risk of developing breast cancer.
A 77-year-old white male complains of urinary incontinence of more than one year’s duration. The incontinence occurs with sudden urgency. No association with coughing or positional change has been noted, and there is no history of fever or dysuria. He underwent transurethral resection of the prostate (TURP) for benign prostatic hypertrophy a year ago, and he says his urinary stream has improved. A rectal examination reveals a smoothly enlarged prostate without nodularity, and normal sphincter tone. No residual urine is found with post-void catheterization.
Which one of the following is the most likely cause of this patient’s incontinence?
In elderly patients, detrusor instability is the most common cause of urinary incontinence in both men and women. Incontinence may actually become worse after surgical relief of obstructive prostatic hypertrophy.
A 47-year-old male is preparing for a 3-day trip to central Mexico to present the keynote address for an international law symposium. He asks you for an antibiotic to be taken prophylactically to prevent bacterial diarrhea.
Which one of the following would you recommend?
While prophylactic antibiotics are not generally recommended for prevention of traveler’s diarrhea, they may be useful under special circumstances for certain high-risk hosts, such as the immunocompromised, or for those embarking on critical short trips for which even a short period of diarrhea might cause undue hardship. Rifaximin, a nonabsorbable antibiotic, has been shown to reduce the risk for traveler’s diarrhea by 77%.
A 40-year-old white male presents with a 5-year history of periodic episodes of severe right-sided headaches. During the most recent episode the headaches occurred most days during January and February and lasted about 1 hour.
The most likely diagnosis is which one of the following?
Cluster headache is predominantly a male disorder. The mean age of onset is 27–30 years. Attacks often occur in cycles and are unilateral. Migraine headaches are more common in women, start at an earlier age (second or third decade), and last longer (4–24 hours). Temporal arteritis occurs in patients above age 50. Trigeminal neuralgia usually occurs in paroxysms lasting 20–30 seconds
novel influenza A H1N1 virus hospitalization tx.
The currently circulating novel influenza A H1N1 virus is almost always susceptible to neuraminidase inhibitors (oseltamivir and zanamivir) and resistant to the adamantanes (amantadine and rimantadine). Zanamivir should not be used in patients with COPD, asthma, or respiratory distress. Antiviral treatment of influenza is recommended for all persons with clinical deterioration requiring hospitalization, even if the illness started more than 48 hours before admission.
secondary amenorrhea
This patient suffers from secondary amenorrhea (defined as the cessation of regular menses for 3 months
or irregular menses for 6 months). The most common causes of secondary amenorrhea are polycystic
ovary syndrome, primary ovarian failure, hypothalamic amenorrhea, and hyperprolactinemia. With a
normal physical examination, negative pregnancy test, and no history of chronic disease, a hormonal
workup is indicated, including TSH, LH, and FSH levels (SOR C).
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